Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

This is the second Bill with the same title that the Government has brought before Members in 2013, both of which were designed to remove medical card coverage from more older people over 70 years of age. It has been an annus horribilis for senior citizens. The position has moved from having in place universal medical card coverage for over-70s under the previous Government to that Government’s move to end universal over-70s coverage altogether. In that regard it was interesting to hear Deputy Kelleher's just-concluded contribution. This was followed by massive protests by older people, on which I commend them, followed by a partial U-turn with provision for the over-70s being made subject to a higher income limit. Under the present Government, that income limit was lowered once in budget 2013 and now has been lowered again in budget 2014, which is being facilitated by the legislation before Members.

Speaking on radio recently, the Minister's Cabinet colleague, the Minister for Public Expenditure and Reform, Deputy Howlin, defended the taking of discretionary medical cards from children with disabilities by asking if it was right that such children from wealthy families should have them. At the same time, however, the Government intends to provide GP cards for all children of five and under from next year, regardless of income or wealth. Where is the consistency in these policies, if one can even refer to them as policies at all? There is no consistency, it is piecemeal and is a case of making it up as one goes along. A Fine Gael-Labour Party Government that states it is committed to the provision of GP care for all at the point of delivery actually is moving in the opposite direction. Discretionary medical cards are being cut back, even for some of the most needy citizens, young and old.

Under this Bill, more people over 70 years of age will lose their cards and fewer will qualify when they reach the age of 70. Prior to 2008, people over 70 received a medical card without a means test. When the Fianna Fáil-led Government decided to end that entitlement, the present Minister for Health, Deputy Reilly, then Fine Gael health spokesperson, described it on the floor of this Chamber as a “vicious attack” and went on to state it was a “savage assault on the elderly”. He was right. Then came the Fianna Fáil-led Government’s climb-down in the face of mass protest by older people. The 2008 legislation set the income limit for over-70s medical card qualification at €700 per week for a single person and €1,400 for a couple. What did Deputy Reilly, then in opposition, say in response? Here in this Chamber he stated it was a “desperate climb-down” that represented but a “tinkering with income limits" and was "nowhere near good enough”. Since then, Deputy Reilly has become Minister for Health.

Has the hardship for older citizens lessened since that day in 2011 when the Minister got his ministerial seal of office? Has the situation improved for our older citizens? No, it certainly has not. Is the removal of medical cards any less an attack today than it was back when it was proposed by Fianna Fáil? The answer again is "No, it definitely is not". However, the difference is that the Minister for Health is now Deputy James Reilly and clearly different standards apply. In budget 2013 we had the dropping of the income limit for medical card qualification for those aged over 70 from €700 per week to €600 for a single person and from €1,400 per week to €1,200 for a couple. It seems that tinkering with income limits, as the Minister described it, is good enough when it is this Government that is doing the tinkering. The problem only arose of course when it was a Fianna Fáil-led coalition. Now in the Bill before us the income limits are being cut again this time to €500 per week for a single person and by a whopping €300 to €900 per week for a couple. It is expected that some 35,000 older citizens will lose their medical cards as a result of this change. Age Action Ireland has stated:"It is contradictory to be removing means-tested cards from a section of society which has high medical needs, in a budget which is rolling out free GP care for children and heralding it as the roll out of its universal primary care plans.”

For all medical card holders prescription charges have been increased to five times the original charge per item introduced by a former Minister for Health, Mary Harney, a measure that both Fine Gael and the Labour Party vehemently opposed here in the Houses of the Oireachtas, as did I. This increase once again hits older people especially badly. This Bill, taken together with the abolition of the telephone allowance and the prescription charges increase, make budget 2014 a particularly nasty one for older people. There is no getting away from that.

I want to remind the Government, as I did when the last Bill of this title was on Second Stage only a little more than six months ago in March, that the Minister, Deputy Reilly, championed Fine Gael’s FairCare health policy with its promise of universal primary care. Fine Gael and the Labour Party received record mandates in the general election in February 2011 with manifestos that promised, first, greatly extended and then universal entitlement to free primary care. The Fine Gael-Labour Party programme for Government tells us that universal primary care will remove fees for GP care and will be introduced within this Government’s term of office. We are also told:

Access to primary care without fees will be extended in the first year to claimants of free drugs under the Long-Term Illness scheme at a cost of €17 million. Access to primary care without fees will be extended in the second year to claimants of free drugs under the High-Tech Drugs scheme at a cost of €15 million. Access to subsidised care will be extended to all in the next phase. Access to care without fees will be extended to all in the final phase.

We had a programme, a plan and were able to consider what was to happen and the steps to be taken. The Minister, Deputy Reilly, promised that the first phase, the extension of free primary care to claimants of free drugs under the long-term illness scheme, would be in place in summer 2012 but that did not happen. There were supposed to be drafting difficulties because of the change from entitlement based on income to entitlement based on forms of illness. In the autumn of last year we were told by the Minister that it was still on track and there would be a Bill.

When the Health (Alteration of Criteria for Eligibility) (No. 1) Bill came before us last March, there was no Bill to extend free primary care in any way. The Minister for Health, Deputy Reilly, had come full circle - from IMO opponent of over 70s universality, to IMO beneficiary of it, to vociferous Dáil opponent of change to it and now to imposing a further restriction to the scheme, leading to thousands of older people losing their medical cards. Again today this Bill, which the Minister presented, further restricts access and plans to cut medical card entitlement for a further 35,000 people.

Both parties, when in opposition, pointed out that restricting access to primary care was penny wise and pound foolish because older people would suffer poorer health outcomes and require more hospital visits, inpatient care and residential nursing home care.

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